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MONITORING WELL INSTALLATION REI- J <br /> Date: CONSmllC� LVd- <br /> Premise Address: /� Total Depth <br /> ILI Screen Length (from) (to) <br /> Well No.: � � " Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: � <br /> Driller: cas Ing <br /> height <br /> Consultant T —W-F <br /> Geologist <br /> A80VE-GROUND CNAtm-BOX <br /> COWLEf10N COMPtEMN <br /> SPECIAL PERMIT INFO. Ground emacs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) n- <br /> If yes, location and distance - ft, <br /> • ft. <br /> = O <br /> SAMPLING slotted <br /> sacaon — <br /> Holding Temperature <br /> ,:>: praval Pack <br /> Method . — <br /> Screening Method <br /> a <br /> Tracking Sheet - (y/ n ) 4. <br /> ft <br /> SPOU S <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) d-/r p J� <br /> Storage Location Casing type <br /> gl� ft. Screenft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />